August 15, 2009 Legislation




The AHA reports the last House committee to report changed the amount paid to providers in the public plan to a negotiated rate between Medicare and private payors.  They also kept in the death knell for physician owned hospitals but dinged the community hospitals about $19 Billion over 10 years due to Medicare patient readmissions.

There was a huge gaff by the Obama subordinates in stating there would be a tax on those below $250,000 to pay for Obama's social programs.  The White House fervently denied and chastised its Secretary of the Treasury and others for speaking the truth. 

Obama continues to back pedal so that he may look good no matter which healthcare bill may finally come out.  He no longer states that all must have insurance which was the reason for the bill in the first place.  He will during the recess attempt to drum up support for the process.  In the meantime, the Senators and Congress people are all taking heat in their districts for the expense of the bill and the social spending in general as these are not creating jobs. This may be the beginning of a shift away from those in Congress and the Senate who spend rashly in a time of recession.

I have mixed feelings about a part of the healthcare bill in the Senate to spend $10 Billion annually for preventive health care.  This would go toward paving paths for bikes and hikes as well as farmer's markets.  The flip side is its potential for just pork.

Senator Schumer is warning that they may pass the healthcare by reconciliation.  This may be done but at their own peril since all not directly related to deficit reduction may be removed. 

The longer the healthcare debate lasts the more problems are found.  The Center for Budget and Policy Priorities has reported potential major flaws in the Senate employer mandate.  They state that the way it is written would discourage business from hiring those most needing jobs.  Business would need to contribute far more money for those not offered health insurance that are in the lower socioeconomic groups.  This is the same as the Congressional Budget Office came up with in their report.

A bipartisan governor call is afraid that the potential healthcare bill will push unfunded Medicaid mandates onto the states.  They are concerned since the Congress is raising the eligibility for Medicaid and not funding it. Baucus says that the US can not afford to do it alone.  Maybe they then should not do it at all.  Remember this was supposed to be only to get the uninsured taken care of.  It was not supposed to be all that is now coming out.

According to Merritt Hawkins, a recruitment firm, the time to get an appointment now across the country is averaging 15 days.  In Boston, where all are insured the time is over two months.  Even those with Medicaid can see a physician within 15 days and only few physicians will see these people due to the low reimbursement.  This make Boston's experience even more telling.

In a new poll by Quinnipiac University 55% vs 35% of people polled are concerned Congress will spend too much money on healthcare vies a vie the deficit.  Even worse was the 71% that did not believe Obama's promise to give healthcare reform without raising the debt.  Sixty percent said there should be no healthcare reform if only Democrats want it.  Only 21% said their healthcare would be improved and 37% said it would be made worse.

The people are not only voting against the healthcare policy in polls but also at the Congressional town meetings.  Some meetings have had the Democratic Congresspeople fleeing from the meeting prior to the completion of the meeting.  This may carry over to their reelection campaigns next year.        Top 


HHS has transferred the authority to interpret and enforce HIPAA security standards to the Office for Civil Rights from the Office of EHealth Standards.

The EHR meaningful use is being sent to HHS with some changes such as all physician orders must be CPOE in the office but only 10% must be CPOE in the hospital.  Physicians MUST maintain an active medication list, incorporate lab test results into the EHR, generate lists of patients with specific conditions for use for quality improvement, report ambulatory quality measures to CMS, send reminders to patients, do billing electronically, give patients "timely" reports on their lab tests, physicians must document advance directives and smoking status and document a progress note for each encounter.  The above is by 2011 if one wants the pennies promised over the dollars spent.        Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.